Chapter2-4

1. Nerve Compression Signs

1) Paresthesia - First sign usually Distal

2) Loss of reflex - Corresponds to affected Nerve

3) Loss of motor function - Corresponds to affected Nerve

* Loss of motor function when progressive or progressive atrophy in the

  thigh or calf are indications for surgical consultation

* The only absolute indiction for surgical consultation is loss of bowel or

  bladder function

4) Lateral Sign

 ➀ Antalgia : Lean away

 ➁ Remarks : Kemp +

5) Medial Sign

 ➀ Antalgia : Lean into

 ➁ Remarks : WLR +

6) Subrhizal

 ➀ Antalgia : Lean forward

 ➁ Remark

7) Central

 ➀ Antalgia : Lean Forward

 ➁ Remark : Caudal Equina

2. Prolapse & Protrusion

1) Protrusion

 ➀ Nucleus : Contained Bulging

 ➁ Valsalva/ Cough : Positive

 ➂ Pain at : Low back > Leg

 ➃ Onset : Chronic(insidious)

 ➄ Distraction : Tension usally

 ➅ Flexion and Extension : Tension on Flex. Ext.

 ➆ Remarks : Sitting pain

2) Prolapse 

 ➀ Nucleus : Migration(Free)

 ➁ Valsalva/ Cough : Negative

 ➂ Pain at : Leg > Low back

 ➃ Onset : Acute

 ➄ Distraction : Not always

 ➅ Flexion and Extension : Only on Flex.

 ➆ Remarks : Antalgia

3. Nerve Root Level

1) Sciatic Nerve

 ➀ Scaral Plexus : L4, L5, S1, S2, S3

 ➁ Sciatic Nerve : Tibial(2/3) and Common Peroneal(1/3) Nerves 

 ➂ At the Distal Third of the Thigh : Into their respecive singular nerves

2) L5 and S1 Nerve Root

 * L5 Nerve Root

 ➀ Disc involved : L4(L4~L5)

 ➁ Sensory : Side Leg, Top Foot

 ➂ Motor : Dosi Flexion

 * S1 Nerve Root

 ➀ Disc involved : L5(L5~S1)

 ➁ Sensory : Back leg, Side foot

 ➂ Motor : Plantar Flexion

4. Sciatic Nerve Radiculopathy

1) Pain

 ➀ Proximal

 ➁ Buttock and Post. Thigh

2) Paresthesia

 ➀ Distal

 ➁ Foot and Calf

5. Disc Diagnosis Algorithm

1) Identify side of Leg Pain

2) Identify Nerve Root

3) Identify Disc Level

4) Identify Protrusion and Prolapse

5) Identify Medial, Lateral, Subrhizal, Central

6) Identify Complicating Factors

 ➀ Pedicogenic Stenosis

 ➁ Developmental Stenosis

 ➂ Lumbar Instability

Tip> Nerve의 여러가지 Sign에 대해서 숙지해 둘것!